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Physiology of The Heart

M. Djauhari Widjajakusumah
Departemen Fisiologi
Fakultas Kedokteran Universitas Indonesia

Mohrman, Heller:

Cardiovascular
Physiology, 6th
Edition 2006

Figure 12.
Cardiovascular circuitry
indicating the percentage
distribution of cardiac
output to various organ
systems in a resting
individual.

Lauralee Sherwood, Human

Physiology:
From Cells to Systems,

7th Ed, 2010

Major body fluid compartments with average volumes indicated for a 70-kg human. Total
body water is about 60% of body weight.

Mohrman, Heller:
Cardiovascular
Physiology, 6th Edition
2006

Lauralee Sherwood, Human

Physiology:
From Cells to Systems,

7th Ed, 2010

Lauralee Sherwood,

Human Physiology: From Cells to Systems,

7th Ed, 2010

FIGURE 9-6 Organization of cardiac muscle fibers. Bundles of cardiac muscle fibers are
arranged spirally around the ventricle. Adjacent cardiac muscle cells are joined end to end by
intercalated discs, which contain two types of specialized junctions: desmosomes, which act as
spot rivets mechanically holding the cells together; and gap junctions, which permit action
potentials to spread from one cell to adjacent cells.

Lauralee Sherwood,

Human Physiology: From Cells to Systems,

7th Ed, 2010

FIGURE 9-6 Organization of cardiac muscle fibers. Bundles of cardiac muscle fibers are
arranged spirally around the ventricle. Adjacent cardiac muscle cells are joined end to end by
intercalated discs, which contain two types of specialized junctions: desmosomes, which act as
spot rivets mechanically holding the cells together; and gap junctions, which permit action
potentials to spread from one cell to adjacent cells.

FIGURE 9-6 Organization of cardiac muscle fibers. Bundles of cardiac muscle fibers are
arranged spirally around the ventricle. Adjacent cardiac muscle cells are joined end to end by
intercalated discs, which contain two types of specialized junctions: desmosomes, which act as
spot rivets mechanically holding the cells together; and gap junctions, which permit action
potentials to spread from one cell to adjacent cells.

Specialized types of junctions


Desmosomes
Consist of a region between two adjacent cells where the
apposed plasma membranes are separated by about 20 nm
Have a dense accumulation of protein at the cytoplasmic
surface of each membrane and in the space between the two
membranes
Protein fibers extend from the cytoplasmic surface of
desmosomes into the cell and are linked to other desmosomes
on the opposite side of the cell.
Desmosomes function to hold adjacent cells firmly together in
areas that are subject to considerable stretching, such as in the
skin.
The specialized area of the membrane in the region of a
desmosome is usually disk-shaped, and these membrane
junctions could be likened to rivets or spot-welds.

Vander et al.: Human Physiology: The


Mechanism of Body Function, Eighth
Edition, 2001

Gap Junction
Structure in plasma membranes of cells that are in direct physical contact
with one another
The two opposing plasma membranes come within 2 to 4 nm of each
other, which allows specific proteins from the two membranes to join,
forming small, protein-lined channels linking the two cells, linking the
cytosols of adjacent cells
Allows cells to have direct communication by allowing small molecules to
pass directly from the cytosol of one cell to the cytosol of an adjacent cell
Gap junctions coordinate the activities of adjacent cells by allowing
chemical messengers to move from one cell to another
The small diameter of the channels (about 1.5 nm) limits what can pass
between the cytosols of the connected cells to small molecules and ions,
such as sodium and potassium, and excludes the exchange of large
proteins
Heart muscle cells and smooth-muscle cells possess gap junctions, play a
very important role in the transmission of electrical activity between the
cells.

Despopoulos, Color Atlas of Physiology 5TH ed 2003 Thieme

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

FIGURE 9-8 Specialized conduction system of the heart and spread of cardiac excitation.

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

FIGURE 9-8 Specialized conduction system of the heart and spread of cardiac excitation.

Impulse Transmission
AV delay
AV node conduction:
Penetrating portion of AV bundle:

0.09 sec
0.04 sec
------------------------------------

PR segment
Atrial impulse conduction
SA node Internodes AV node:

0.13 sec
0.03 sec
------------------------------------

PR interval

0.16 sec

Conduction Velocity
Myocardium
Atrium:
0.3 m/sec
Ventricle:
0.5 m/sec
Special Conducting System
Internodal pathways:
Transitional fibers:
AV Node:
Purkinje fibers
(Bundles of His, terminal fibers):

1
m/sec
0.02 m/sec
0.05 m/sec
1.5 - 4.0 m/sec

AV Node Slow Conduction


Small cells
Thin cell membrane slow conduction velocity
Resting Em < Myocardium resting Em
Small amplitude of action potential slow conduction
velocity
Few intercalated disc
Great intercellular electrical resistance slow conduction
velocity

Purkinje Fiber

Fiber diameter > myocardium diameter


Conduction velocity > conduction velocity in myocardium
Smaller intercalated disc electrical resistance
Conduction velocity > conduction velocity in myocardium

Figure 15-19 Typical action potentials (in


millivolts) recorded from cells in the ventricle
(A), SA node (B), and atrium (C). Sweep
velocity in B is one-half that in A or C. (From
Hoffman BF, Cranefield PF: Electrophysiology
of the heart, New York, 1960, McGraw-Hill.)

Richard E. Klabunde 2012, Cardiovascular PhysiologyConcepts

Fig 2-2. Time course of membrane


potential and ion permeability
changes that occur during "fast
response" (left) and "slow
response" (right) action potentials

Mohrman & Heller: Cardiovascular Physiology, 6th Ed 2006

Figure 22.
Action potentials from these cell types are referred to as "fast response"
and "slow response" action potentials, respectively.

Panel A: fast response action potentials are characterized by

a rapid depolarization (phase 0) with a substantial overshoot (positive


inside voltage),
a rapid reversal of the overshoot potential (phase 1),
a long plateau (phase 2),
and a repolarization (phase 3)
a stable, high (ie, large negative) resting membrane potential (phase
4).

Panel B: the slow response action potentials are characterized by a slower


initial depolarization phase, a lower amplitude overshoot, a shorter and
less stable plateau phase, and a repolarization to an unstable, slowly
depolarizing "resting" potential. The unstable resting potential seen in
pacemaker cells with slow response action potentials is variously referred
to as the phase 4 depolarization, diastolic depolarization, or pacemaker

potential.

Mohrman & Heller: Cardiovascular Physiology, 6th Ed 2006

Figure 22 Panels C and D

The resting phase


o

The membranes of both types of cells are more permeable


to K+ than to Na+ or Ca2+. Em resting are close to the
potassium equilibrium potential (of 90 mV)

The slow depolarization phase in the pacemaker-type cells


o

A progressive decrease in the membranes permeability to


K+ during the resting phase

The permeability to Na+ increases slightly. The gradual


increase in the Na+/K+ permeability ratio will cause the
membrane potential to move slowly away from the K+
equilibrium potential (90 mV) in the direction of the Na+
equilibrium potential

Third, an increase in the permeability of the membrane to


calcium ions, which results in an inward movement of
positively charged ions and also contributes to the diastolic
depolarization.
Mohrman & Heller: Cardiovascular Physiology, 6th Ed 2006

FIGURE 2.5
Changes in ion conductances associated
with a ventricular myocyte action
potential.
Phase 0 (depolarization) primarily is due
to the rapid increase in sodium
conductance (gNa+) accompanied by a
fall in potassium conductance (gK+)
The initial repolarization of phase 1 is
due to opening of special potassium
channels (Ito)
Phase 2 (plateau) primarily is due to an
increase in slow inward calcium
conductance (gCa++) through L-type
Ca++ channels
Phase 3 (repolarization) results from an
increase in gK+ and a decrease in gCa++
Phase 4 is a true resting potential that
primarily reflects a high gK+. ERP,
effective refractory period.

Richard E. Klabunde 2012, Cardiovascular PhysiologyConcepts

Changes in Na+ and K+ conductance during the action potential in giant squid axon. The dashed
line represents the action potential superimposed on the same time coordinate. Note that the initial
electrotonic depolarization initiates the change in Na+ conductance, which in turn adds to the
depolarization. (Modified from Hodgkin AL: Ionic movements and electrical activity in giant nerve
fibers. Proc R Soc Lond Ser B 1958;143:1.)

Guyton & Hall: Textbook of Med Physiol 11th ed, 2006

Figure 102
Rhythmical discharge of a sinus nodal fiber. Also, the sinus nodal action potential is compared
with that of a ventricular muscle fiber.

Figure 15-20 Mechanisms involved in the changes in frequency of pacemaker firing. In A, a


reduction in the slope (from a to b) of slow diastolic depolarization diminishes the firing frequency.
In B, an increase in the threshold potential (from TP-1 to TP-2) or an increase in the magnitude of
the resting potential (from a to d) also diminishes the firing frequency. (From Hoffman BF,
Cranefield PF: Electrophysiology of the heart, New York, 1960, McGraw-Hill.)

Lauralee Sherwood, Human

Physiology:
From Cells to Systems,

7th Ed, 2010

Mohrman & Heller:


Cardiovascular Physiology,
6th Ed 2006

Richard E. Klabunde 2012, Cardiovascular Physiology Concepts

Figure 15-2 Time relationships between the developed force and the changes in
transmembrane potential in a thin strip of ventricular muscle. (Redrawn from Kavaler
F, Fisher VJ, Stuckey JH: Bull NY Acad Med 41:592, 1965.)

Lauralee Sherwood, Human

Physiology:
From Cells to Systems,

7th Ed, 2010

Cardiac versus Skeletal Muscle AP

Refractory Period

Atrium

Ventricle

Absolute refractory period

0.15 sec

0.25 - 0.30 sec

Relative refractory period

0.03 sec

0.05 sec

------------------------------------

--------------------------------------------------------------

0.18 sec

0.30 - 0.35 sec

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

Ganong Review of
Med Physiol 22nd ed,
2005

Diagram of the changes in pressure and velocity as blood flows through the systemic circulation.
TA, total cross-sectional area of the vessels, which increases from 4.5 cm2 in the aorta to 4500
cm2 in the capillaries (Table 301). RR, relative resistance, which is highest in the arterioles.

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition,
Lauralee Sherwood, 2010

The mean arterial pressure is the average pressure driving


blood forward into the tissues throughout the cardiac
cycle.
Mean arterial pressure is not the halfway value between
systolic and diastolic pressure.
Arterial pressure remains closer to diastolic than to
systolic pressure for a longer portion of each cardiac
cycle.
At resting heart rate, about two thirds of the cardiac cycle
is spent in diastole and only one third in systole.

Berne, et al: Physiology, 5th ed,


2007

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Lauralee Sherwood, Human

Physiology:
From Cells to Systems,
7th Ed, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood,
2010

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Control of Cardiac Output


Peripheral resistance

Cardiac output
+

vasoconstriction
arterioles
+

Heart rate
_
+

Extrinsic
control

Stroke volume
Contractility

Intrinsic control
Parasympathetic
activity

Sympathetic activity
(and epinephrine)

End-diastolic
volume
+

Human Physiology:
From Cells to Systems,

Seventh Edition, Lauralee Sherwood, 2010

Extrinsic
control

Intrinsic control
+

Venous return

Factors that Increase Cardiac Output


Cardiac output = Stroke Volume X

SA Node

Cardiac muscle

End-Diastolic Volume

Heart Rate

Epinephrine & Norepinephrine

Acetylcholine

Venous return

Adrenal Med
& Sympathetic
Nerve Activity

Parasympathetic
Nerve Activity

Muscle Pump &


Respiratory Pump

Cardio-Accelerator &
Vasomotor Centers
(Medulla)

Cardio-Inhibitory
Center (Medulla)

Exercise

Stress

Low Blood Pressure

Ganongs Review of Medical


Physiology, 23rd ed, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Blood Pressure : Neural Regulation


Blood Pressure
Baroreceptors
output

Cardiovascular Centers
sympathetic output

Blood Vessels
vasoconstriction

parasympathetic output

Heart
Heart Rate
(SA Node)
Stroke volume

Blood Pressure

Heart
Heart Rate
(SA Node)

Blood Pressure : Hormonal Regulation


Baroreceptors

Blood pressure

Baroreceptors
In arch of aorta &
carotid sinuses.
Output

In kidneys
Secretion of renin

Sensory nerve fibers

Blood
Angiotensin II
activated
Adrenal Cortex
Aldosterone
released

Posterior pituitary
ADH released

Blood Vessels
vasoconstriction

Kidneys
water
reabsorption

Kidneys
water
reabsorption

Blood Vessels
vasoconstriction

Blood pressure

CV Center
sympathetic output

Adrenal Medulla
Epinephrine
released

Heart
Heart rate
(SA node)
Stroke volume
(Cardiac muscle)

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Lauralee Sherwood, Human

Physiology:
From Cells to Systems,
7th Ed, 2010

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Figure 317.

Basic pathways involved in the


medullary control of blood pressure.
The vagal efferent pathways that slow
the heart are not shown. The putative
neurotransmitters in the pathways are
indicated in parentheses. Glu, glutamate;
GABA,-aminobutyric acid; Ach,
acetylcholine; NE, norepinephrine; IML,
intermediolateral gray column; NTS,
nucleus of the tractus solitarius; CVLM,
IVLM, RVLM, caudal, intermediate, and
rostral ventrolateral medulla; IX and X,
glossopharyngeal and vagus nerves.

+
+

Ganongs Review of Medical


Physiology 22nd, 2006

Components of the arterial baroreceptor


reflex pathway. nts, nucleus tractus
solitarius; rvlm, rostral ventrolateral
medullary group; rn, raph nucleus; na,
nucleus ambiguus; ??, incompletely
mapped integration pathways that may
also involve structures outside the
medulla.
Lange Cardiovascular Physiology, 2006
The McGraw-Hill Companies.

Nucleus ambiguus:
The nucleus of origin of
motor fibers of the vagus,
glossopharyngeal, and
aaccessory nerves that suplay
the striated muscles of the
larynx and pharynx.
(Dorlands Illustrated Medical
Dictionary 27th ed, 1988
W.B.Saunders Company)

Human Physiology:
From Cells to Systems,

Seventh Edition
Lauralee Sherwood, 2010

Lauralee Sherwood, Human

Physiology:

From Cells to Systems, 7th Ed, 2010

Lauralee Sherwood, Human Physiology:


From Cells to Systems, 7th Ed, 2010

Lange Cardiovascular
Physiology, 2006 The McGrawHill Companies

Lauralee Sherwood, Human

Physiology:

From Cells to Systems, 7th Ed, 2010

Lauralee Sherwood, Human

Physiology:
From Cells to Systems, 7th Ed, 2010

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